In matters of the heart, women still get short shrift
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When it comes to heart attacks, women are still second-class citizens.
They are slowly catching up with men, but they are still less likely to receive adequate treatment in the hospital, particularly in the first few hours after a heart attack occurs. As a result, they are still twice as likely as men to die from the most severe form of heart attack, according to a new study in Circulation: Journal of the American Heart Assn.
And that is at the best hospitals, a select group that has pledged to follow the latest guidelines for what is known as evidence-based care -- that is, treatments that have been shown to work in clinical trials. At nonparticipating hospitals, experts fear, the disparity is most likely much worse.
Women already have a couple of strikes against them before they reach the hospital. Historically, women tend to have their heart problems about 10 years later than men, perhaps because of the protective effects of estrogen. But that means that when they do have a heart attack, they are more likely to be suffering from other health problems as well, complicating treatment. And some studies have also shown that women are less likely to recognize the initial stages of a heart attack -- or more willing to endure the pain -- delaying their decision to seek treatment.
Once they do get to the hospital, they are less likely to be treated effectively.
Dr. Hani Jneid of the Baylor College of Medicine in Houston and her colleagues studied more than 78,000 heart attack patients admitted to 420 hospital between 2001 and 2006. All the hospitals were participants in the American Heart Assn.’s Get With the Guidelines program designed to ensure that patients received evidence-based care.
They found that, compared with men, women were:
- 14% less likely to receive aspirin immediately;
- 10% less likely to receive beta-blockers;
- 25% less likely to receive clot-busting enzymes; and
- 13% less likely to receive balloon angioplasty within 90 minutes of hospital arrival.
As a consequence, 10.2% of women suffering the most severe form of heart attack, called ST-elevation myocardial infraction or STEMI, died within the first 24 hours, compared with 5.5% of men.
One caveat: Other studies have shown that women suffering a heart attack are more likely than men to survive and reach the hospital. Thus it could be possible that the women who do get there are sicker than the men and thus more likely to die no matter what therapy they are given.
--Thomas H. Maugh II